Contrast-induced encephalopathy after Flow-diverting stents for the treatment of cerebral artery aneurysms：a Case Report

Background Aneurysm interventional embolization is one of the main treatment methods for intracranial aneurysm, which has significant advantages due to its minimally invasive nature, but a variety of complications may still occur during and after surgery, among which contrast-induced encephalopathy (CIE) is a rare but potentially life-threatening neurological complication. CIE is a rare neurological complication after the use of endovascular contrast agents, usually occurring after coronary angiography, cerebral angiography, or interventional therapy, CIE usually occurs 2 to 12 hours after contrast injection, and usually disappears after 24 to 72 hours. The clinical manifestations are acute neurological impairment, including focal neurologic deficits (hemiplegia, hemianopia, cortical blindness, aphasia, and Parkinson's disease) and systemic symptoms (confusion, seizures, and coma). CT or MRI scans of the brain may be transiently positive. Case presentation A 60-year-old woman was admitted to hospital with ischemic cerebral infarction 1 year ago. The first digital subtraction angiography (DSA) identified the right middle cerebral artery (MCA) stenosis and a saccular aneurysm with daughter sac of 2 mm ∗ 3 mm in size in the C7 segment of the left internal carotid artery (ICA). At that time, surgery was performed on arterial stenosis, and the operation was successful. In order to further treat the aneurysm, the patient underwent Flow-diverting stent placement under local infiltration anesthesia, and the operation was successful, however, the patient was unable to speak, unable to understand conversation, irritable, and had no voluntary movement of the right limb after surgery. The non-contrast cerebral CT indicated widespread edema in the left cerebral hemisphere. The patient was diagnosed with CIE and treated with symptomatic supportive therapy. Eventually, the patient’s neurological deficits and cerebral edema improved significantly. Conclusions The current case emphasized the importance of early diagnosis and symptomatic treatment of CIE. Thus, CIE should be the first consideration during the differential diagnosis of a patient having acute neurological impairment after repeated DSA.